PROJECT SUMMARY In the United States, firefighters and emergency medical technicians (EMTs)/ paramedics respond to more than 50 million emergency calls annually. The daily operations and experiences that are expected and accepted as part of their job expose them to various traumatic events (e.g. school shootings, suicides). The nature, frequency, and intensity of duty-related traumatic exposures place these first responders (FRs) at significant risk for mental health (MH) problems, such as post- traumatic stress disorder (PTSD) and suicide. However, due to the stigma of mental illness and the culture of self-reliance and strength that surrounds FRs, few are willing to seek help. In a preliminary study conducted by the Principal Investigator, community partnerships were established with key FR stakeholders throughout Arkansas to discuss MH- related issues. They unanimously expressed concern about the increased prevalence of MH problems and lack of help- seeking among FRs in the state. Hence, we propose an exploratory, qualitative study that will use a statewide community- engagement approach to conceptualize a MH service model that FRs will be willing to access and use. Our specific aims are to: AIM 1) Identify FRs' preferences and priorities regarding MH service and delivery methods, including the feasibility, acceptability, and value of each method. To address this aim, we will use opt-in methods to recruit a diverse group of firefighters and EMTs/paramedics from across Arkansas to participate in qualitative interviews, defined as focus groups and individual interviews. After all qualitative interviews have been analyzed, we will initiate a series of product development activities to achieve AIM 2) Conceptualize a MH service model, in partnership with FRs statewide, that is applicable, acceptable, and feasible for implementation. In collaboration with our community partners, and based on the preferences and priorities identified by FRs, a hybrid Delphi technique of consensus formation will be used to conceptualize a MH service model that is acceptable to FRs and feasible to implement in real world settings, which aligns with the National Institutes of Mental Health (NIMH) Research Priorities (Strategic Objective 4.1 and 4.2). Through this work, we will generate the scientific foundation to develop a comprehensive, MH service model that will motivate engagement in services by diverse FRs. We expect this model will encompass a range of services, such as awareness, prevention, treatment, and crisis management strategies to meet FRs' MH needs throughout the course of illness. This study's findings will guide a multi-stage, research agenda that will include: 1) development and pilot testing of the MH service model (Strategic Objective 4.3), 2) a full-scale trial of the program statewide, revised based on pilot results, and 3) a hybrid effectiveness-implementation trial (Strategic Objective 4.4). Ultimately, promoting engagement in MH services may decrease suicide rates and improve the overall MH outcomes among this at-risk population. With continued efforts and partnerships, findings can be integrated into policy and funding-related decision making to sustain the delivery of high-quality MH services for FRs in Arkansas and across the nation.